Laparoscopic Hepatic Lobectomy: Advantages of a Minimally Invasive Approach

BACKGROUND: As compared with open hepatic lobectomy (OHL), laparoscopic hepatic lobectomy (LHL) carries a substantial learning curve and potential for improved perioperative outcomes. The purpose of this analysis was to compare the outcomes of patients undergoing LHL with those of patients undergoing OHL. METHODS: Analysis of a 1,545-patient prospective hepato-pancreatico-biliary database from January 2000 to June 2009 identified 450 hepatic lobectomy patients, in whom 90 were LHL. A 4:1 case-matched analysis comparing LHL with 360 OHL patients, controlling for age, American Society of Anesthesiologists class, tumor size, histology, and tumor location was performed. RESULTS: A total of 450 patients underwent hepatic lobectomy for malignant or benign lesions, with LHL performed in 90 (20%) patients. There was a significant increase in the percentage of LHL performed during 3 intervals of time: 1995 to 1999, 0%; 2000 to 2004, 1%; 2005 to 2009, 24% (p < 0.0001). There were no significant differences in age (60 versus 62 years), American Society of Anesthesiologists class, body mass index (28.1 versus 26.4), size of largest tumor (4.0 cm versus 6.4 cm), location of tumor(s), or number of tumors (1 versus 1) comparing LHL versus OHL, respectively. There were substantial differences in estimated blood loss, Pringle maneuver, transfusion requirements, complications, and length of stay. Proportional hazards model for all 450 patients demonstrated that OHL (odds ratio = 2.5; 95% CI, 1.2-8.7), blood transfusion, and blood loss were all independently associated with increased complications. CONCLUSIONS: In this prospective evaluation, LHL was associated with substantial improvements in operative rime, Pringle maneuver time, blood loss, transfusion requirements, length of stay, and morbidity without compromising resection margins. These results suggest that LHL is appropriate in selected patients with hepatic tumors. (J Am Coll Surg 2010;210:627-636. (C) 2010 by the American College of Surgeons)